Service in
Heart Care (Cardiology)

Left Atrial Appendage Closure

Left atrial appendage closure is a heart care service at M Health Fairview that helps reduce the risk of stroke in patients with atrial fibrillation. Care is provided by experienced cardiologists as part of our comprehensive approach to heart health.

Overview

Left Atrial Appendage Closure is a procedure for patients with a desire to eliminate their need for oral anticoagulation, while also offering stroke protection. For many adults, being on Oral Anticoagulants can be bothersome. Adults might consider eliminating their need for Oral Anticoagulants due to their job or occupation, a history of bleeding issues, cost of medications, risk of falls, or difficulty maintaining therapeutic INR while on warfarin.

Our approach

Prior to Procedure
Before being scheduled for Left Atrial Appendage Closure, your Provider may require you have an assessment of your heart function. This is most often completed by an echocardiogram, or ultrasound of the heart.

  • Imaging: The Doctor performing your Left Atrial Appendage Closure procedure may require you have imaging done of your heart prior to your procedure.
  • Office Visits: Before being scheduled for your procedure, you’ll need a formal consult with one of our APPs to determine if you are a good candidate for the procedure and discuss the risks and benefits of the procedure. Additionally, insurance requires you meet with another Doctor (who does NOT perform the Left Atrial Appendage Closure), for them to a discussion on whether or not the procedure is right for you. This office visit is commonly known as a Shared Decision Making visit.
  • Pre-Op: At your pre-procedure appointment, a full History and Physical will be completed. During this History and Physical, we will perform some blood tests to ensure you are in good health to move forward with your procedure, as well as an ECG.

Procedure Overview
Left Atrial Appendage Closure is performed in the heart catheterization laboratory at the hospital. This is where many catheter-based heart procedures are performed. This procedure does NOT require open heart surgery. You will be given general anesthesia, and a breathing tube will be placed. A TEE probe is then placed down your esophagus to provide images throughout the procedure.

An puncture is then made in the large vein in your groin, the femoral vein. The doctor will then guide a heart catheter, or hollow tube, up your vein and into your heart, specifically into the Left Atrial Appendage. Once in the Left Atrial Appendage, the Closure device is introduced into the Left Atrial Appendage, permanently sealing off the appendage and preventing blood from entering the appendage.

Once the Closure device has been placed, the lines and tubes will be removed and you will complete a short period of bedrest. Most patients will go home the same day if they have someone to drive them home and a responsible adult to spend the first 24 hours with them.

Benefits
Benefits of the procedure include the ability to eliminate need for oral anticoagulant while also providing patients with some stroke protection.

Risks
The most common post-procedural concerns are bruising and puncture site bleeding.

Risks are discussed with patients at time of consult by an Advanced Practice Provider, which include <2% chance of device embolization, air embolism, myocardial perforation, device thrombosis, ASD, stroke, or death.

Recovery
Once the procedure is completed, you must complete a period of bedrest determined by the Doctor who implanted your Left Atrial Appendage Closure Device. You will have lifting and driving restrictions. You may also be limited in your ability to visit the dentist after your procedure.

Monitor your incision a few times a day in the first days following your procedure.

Follow-Up
Once your procedure is completed, you will need to be seen in clinic for follow-up at certain time intervals. Imaging of your Left Atrial Appendage Closure Device will also be required.